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[Contrast agent improves diagnostic value of dobutamine stress echocardiography]
H Uehara1, T Yamamoto, Y Hirano
1First Department of Internal Medicine, Kinki University School of Medicine, Ohnohigashi 377-2, Osakasayama, Osaka 589-8511.
Insights
Albunex contrast agent improved endocardial border visualization during dobutamine stress echocardiography. This enhancement increased diagnostic accuracy, particularly for the left circumflex artery territory in patients with coronary artery disease.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Suboptimal endocardial definition limits stress echocardiography's diagnostic value for coronary artery disease.
- Intravenous contrast agents may improve endocardial border delineation.
Purpose of the Study:
- To evaluate if Albunex, a left ventricular contrast agent, enhances endocardial border delineation.
- To determine if Albunex improves the diagnostic value of dobutamine stress echocardiography.
Main Methods:
- Fifty-six patients underwent dobutamine stress echocardiography with and without Albunex infusion.
- Endocardial delineation was scored in six left ventricular segments.
- Diagnostic values (sensitivity, specificity, accuracy) were assessed for different coronary artery territories.
Main Results:
- Albunex significantly improved endocardial delineation scores across multiple left ventricular segments, especially in the lateral wall.
- Diagnostic accuracy improved in the left circumflex artery territory (p < 0.05) but not in the left anterior descending artery territory.
- Albunex enhanced sensitivity and accuracy for left circumflex artery disease detection.
Conclusions:
- Albunex contrast agent improves endocardial visualization during dobutamine stress echocardiography.
- The use of Albunex enhances diagnostic accuracy for coronary artery disease in the left circumflex artery territory.
Objectives:
Suboptimal endocardial definition reduces the diagnostic value of stress echocardiography for coronary artery disease, but intravenous infusion of a left ventricular contrast agent (Albunex) may enhance endocardial border delineation and improve the diagnostic value of dobutamine stress echocardiography.
Methods:
Fifty-six patients, 38 with myocardial infarction, 16 with angina pectoris and two normal subjects, were enrolled in this study. Dobutamine was infused in scalar doses of 5 to 40 micrograms/kg/min. Intravenous infusion of Albunex (0.15 ml/kg) was administered at rest and during peak dobutamine stress during monitoring of the apical four-chamber view. The left ventricle in the apical four-chamber view was divided into six segments and an endocardial delineation score of 0 to 3 (none to excellent visualization) was given to each segment.
Results:
Endocardial delineation score was increased after Albunex infusion from 2.0 to 2.3 in the basal-septal, 2.0 to 2.4 in the mid-septal, 1.1 to 1.8 in the apical-septal, 0.7 to 1.2 in the apical-lateral, 0.9 to 1.6 in the mid-lateral, and 1.2 to 1.9 in the basal-lateral segments during peak dobutamine administration. Endocardial border resolution in the lateral wall showed greater improvement than in the septal wall after Albunex infusion. Diagnostic values in the left anterior descending artery territory failed to improve with Albunex infusion (sensitivity 82% to 89%, specificity 94% to 89%, and accuracy 86% to 89%), whereas a higher diagnostic accuracy was noted in the left circumflex artery territory with Albunex compared to without Albunex (sensitivity 63% to 81%, specificity 88% to 98%, and accuracy 80% to 93%, p < 0.05).
Conclusions:
Contrast agent improves the diagnostic accuracy of dobutamine stress echocardiography in the left circumflex artery territory.